Effective patient care versus revenue cycle management: physicians perform a balancing act

Physicians in the U.S., despite ranking high for their medical competence, have never been able to fully realize and optimize their medical bill reimbursements owing to an increasingly complex health insurance system that has been constantly evolving, and characterized by:

• HIPAA Compliant Medical Reporting
• Stringent Billing and Coding Regimen
• Technological Interface for Electronic Billing and Coding
• Multiple-payer Health Care System, both Private Insurance Plans, and Federal Health Plans such as Medicare and Medicaid.

Physicians, whose core concern being the elevation of medical care in congruence with the ever evolving global competitive benchmark, have reported medical billing managementto be an undesirable diversion that can negatively impact their medical efficiency. Experimentation with in-house medical billing practice has not been encouraging either – with in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation. Consequently, physicians – with no avail but to practice medical billing somehow – have inevitably been driven to seek professional help in medical billing from medical billing specialists.

Experience has shown that successful medical billing has followed the dictum of perpetual reinvention in tune with stringent compliant standard (coding compliance), privacy compliance regimen (as per HIPAA), and ever advancing technological platforms for billing management cycle – all of which have contributed to an imposing environment that demands a highly qualified, experienced and dynamic team of medical billers, who along with a comprehensive knowledge of billing, are adept at conducting medical billing management in a sequential manner:

• Patient Enrollment
• Scheduling
• Insurance Verification
• Insurance Authorizations
• Scheduling and Re-scheduling
• Coding
• Billing and Reconciling of Accounts
• Collections
• AR Collections
• Denial Management & Appeals

Consequently, physicians’ search for comprehensive medical billing service has led them to leading medical billing specialists, such as Medicalbillersandcoders.com – the largest consortium of medical billing professionals, who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards.

Carrying impeccable qualifications – certified by the American Association of Professional Coders (AAPC); proficient in using advanced medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc., and latest coding softwares such as EncoderPro, FLashcode and CodeLink, these medical billing specialist help physicians to streamline their current operations.

Expert at applying standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis; HIPAA compliant medical reporting; and an impressive track-record of maximizing reimbursement of medical bills with the leading private insurance carriers such as United health , Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well – our medical billing experts ensure simplification of your revenue cycle, appreciable increase in collection rates and operational margins, more patient inflow and referrals, and Increased avenue for medical research and development.

San Francisco Medical Billing | SAN JOSE Medical Billing | Seattle Medical Billing

Outsourced Medical Billing – the prescription for new practices’ impressive ROI

Given the rapidly expanding patient base, and an insatiable demand for quality medical care, it is not surprising that each passing-by moment is witness to the birth of a new practice. Despite being driven by a larger healthcare vision, new practices – operating in a market-driven environment – are inevitably forced to lend equal significance to Rate of Return on Investment (ROI), which is the operational yard-stick for sustenance and growth in a highly competitive medical service market.

If pooling in the requisite resources to launch your medical services is one huge task, operating it on profitable basis is altogether a different proposition. Having ventured into a socially-responsible service, most of your time and resources will be expended on employing the best of physicians, diagnostic and curative measures, support and administrative staff, and facilities – all of which have direct impact on quality medical care, patient satisfaction, patient retention, and credibility that would further expand your patient referrals.

Assuming that you go on, and eventually achieve the objective you set out for – medical service credibility – would there be any guarantee that you would have achieved an equally credible and sustainable Rate of Return on Investment (ROI)? Medical bill realization, which is a matter of insurance coverage, would weigh heavily on venture practices, who are generally novice to stringent billing regimen governed by CMS. Further, a full-fledged in-house medical billing team may not be advisable as it, being slow to yield results, is equally capital-intensive requiring heavy investment on: Installation of Billing and Coding Platforms, and Training the staff on best practices in medical billing.

Amidst the prevalence of such uncertainty on in-house medical billing results, it is prudent to source your medical billing needs from a competent outside agency;

• Application of Advanced Technology Interface comprising use of latest medical billing softwares such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc.,
• Use of latest coding softwares such as EncoderPro, FLashcode and CodeLink
• Application of standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting
• Successful track-record of processing medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well

Beyond the above requirements, the Medical Billing agency must also provide comprehensive medical billing complete with:

• Patient Enrollment
• Insurance Enrollment
• Scheduling
• Insurance Verification
• Insurance Authorizations
• Charge Entry
• Coding
• Billing and Reconciling Of Accounts
• Denial Management & Appeals, and
• Physician Credentialing

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billers in U.S. for over a decade, and whose medical billing service – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, account receivables, and compliance standards – can be an ideal solution for new practices that require phased implementation of medical billing process before considering in-house medical billing themselves.

Going by the recent statistics – 30 to 40% reduction in medical billing costs – our comprehensive billing solution is the prescription for new practices that seek an impressive ROI through simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and increased avenue for medical research and development.

Cleveland Medical Billing | Charlotte Medical Billing | Chicago Medical Billing

Avenue for Optimizing Dental Practice Revenue

Unprecedented increase in qualified dental practitioners, technological advancement, and market-driven competition has all contributed to continual decrease in operating margins. The fact that dental practitioners, whose core-concern is to maintain highest standard in dental care, rarely find time or resources to address revenue issues has further compounded the issue. But, there exists unanimous consensus on leveraging people, process and technology to positively impact operational efficiency and revenues.

Consequently, identification of functional entities that require well-coordinated efforts towards realizing the objective of operational efficiency and revenue maximization becomes crucial. Generally, Patient Registration, Patient Scheduling, Eligibility Verification (EV) and Benefits, Cash Posting, Analysis, Insurance Follow up, Denial Management, and Patient Collections are the areas that need to be managed in a sequential manner.

Patient Registration

Patient Registration, which involves creating or updating the personal details of the patient, guarantor & subscriber in the system database, enables entry & archiving of the patient’s coverage information in the system.

Patient scheduling


Patient scheduling, both for new and follow up appointments, ensures time-specific appointment with dentists, resulting in optimum time management. As in dental practices follow up and procedure visit are recurrent and delays and cancellation of appointment happen frequently.

Eligibility Verification and Benefits

Eligibility Verification and Benefits find out whether the patient is eligible for dental insurance, and if so, to what extent: preventive, basic or major. Establishing a proper communication channel with the patients’ insurance providers is crucial to mitigate undesirable delays or denial of dental bills.

Cash Posting

Cash posting is the act of applying the insurance payments to the patients’ account, which ensures reconciliation of medical bills on your billing system.

Claim Analysis

Analysis is a crucial effort that identifies causes for claims held up for too long, and devises means – such as modifiers, and resubmission – to speed up the realization of Account Receivables. Ideally, Accounts Receivables Analyst ensures that AR is under control & acceptable by industry standards.

Denial Management

Denial Management is the process of devising suitable action on denied claims. Usually, it comprises reprocessing the claim for payment and closing of the claim.

Patient Collections

Patient collection takes care of informing patient about the portion of their bill payable by them individually and time period for payment before moving the account to a collection agency.

Browse All: Medical Billing

Thus, having a billing mechanism that can ideally complement your dental practice will render the realization of following benefits:

• Positive impact on cash flow and performance
• Improved patient experience and satisfaction
• Access to competitive advantage.
• Increased cash flow and lower expenses.
• Achieving a Higher Return on Investment (ROI).
• Provision for cost predictability
• Quantifiable and sustainable improvements to your dental practices through custom-made strategies to address competence of existing resources, prioritization of tasks, and implementation and monitoring of divisional goals

Of late, social media tools – blogs, Facebook, Twitter and other viral marketing opportunities – too have their significance in broadening dental patient base along with operational tools for cost and revenue optimization. Therefore, applying social media tools for marketing propaganda over the web media in tandem with the regular cost and revenue optimization measures is an ideal combination for comprehensive optimization of your dental practices.

Owing to the complexities involved, dental practitioners have often reported these strenuous optimization exercises as detrimental to their core medical efficiency, and outsourcing as the best recourse. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – whose optimization measures are complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – is the prescription for simplification of your revenue cycle, appreciable increase in collection rates, more patient inflow and referrals.

For more information visit: Tucson Medical Billing, Seattle Medical Billing

Level of Preparedness for Smooth Transition to ICD-10

US Federal Government, which has earmarked October 1, 2013 as the deadline, has sought to replace the 30-year-old ICD-9 with the radical ICD-10 – believed to be harbinger of sweeping changes across all facets of healthcare organizations: providers, staff, processes, insurance carriers, and systems and technology.

But, given the experience in other countries – UK, France, Australia, Germany, and Canada, which prior to adopting ICD-10 in 1995, 1996, 1998, 2000, and 2001 respectively, had to wait as long as 5 years for achieving successful implementation of ICD-10 – it is only expected that the incubatory period from 2010 to 2013 is going to be spent on implementation alone across the length and breadth of the U.S. healthcare system.

Further, transition involving multiple constituents – ICD-10 CM, used in both inpatient and outpatient settings, replacing ICD-9-CM volumes 1 and 2; ICD-10-PCS replacing ICD-9-CM volume 3 for use in inpatient settings only; and, more importantly, the implementation of the HIPAA compliant 5010 standard, a prerequisite to ICD-10 since the current HIPAA 4010 standard does not support ICD-10 codes – is sure going to make it excruciation for all covered entities, including health plans, healthcare clearinghouses and most healthcare providers.

Fortunately, experiences historically in other nations should both be an indicator of challenges that lie on the way, as well as guidelines for realizing smooth transition by the deadline of October 1, 2013. Combining these experiences with the following implementation guidelines should not only make the transition less excruciating but also enable an early interoperable health data exchange in the US, and improve the ability to measure medical processes and outcomes:

Analyzing the chasm between the current system and the demands of ICD-10 system

One of the important tasks prior to implementing the ICD-10 is to analyze the gap between the current system – both technical as well as human – and the projected demand of ICD-10 system. Fundamentally the areas that require a re-look are technology, including interface and interoperability requirements; education and Training; workflow and organizational processes, including clinical documentation, health Information management (HIM) department, clinical service areas and back-office administrative and billing functions and processes, coding productivity and workflow, data quality, data and information reporting – internal and external, and revenue cycle processes and workflow.

Having analyzed the gap with respect to the above parameter above, there comes the need to align the requisites in line with the ICD-10 demands

Education and Training

Having analyzed the areas to be upgraded in line with the demands, the next step is to educate and train the human resources that actually are going to be impacted. Primarily, the following sections of manpower are going to be in need of the education and training in line with the ICD-10:

• Health Information Management (HIM) professionals (regardless of departmental affiliation or the presence of centralized or decentralized coding practices)
• Administrative and front office staff such as Registration or Scheduling departments
• Clinical staff – physicians and all other allied health professionals who may document the patient health record
• Revenue Cycle and Business office support staff, including contract managers, documentation reviewers and corporate compliance officers
• Finance Department staff
• Departmental and other management staff including quality and utilization management, performance improvement and other key areas that may use or report ICD codes
• Clinical Documentation Improvement

Educating and training your staff alone is not going to make any difference unless there is considerable improvement in clinical documentation, which, along with successful compliance with HIPAA norms, enables best coding practices as per ICD-10. Hence, the resources spent on education and training should reflect on the quality of clinical documentation.

Browse All: Baltimore Medical Billing

Tactful Management of Revenue Cycle

ICD-10, being exhaustive and stringent, has the potential to negatively impact your revenue cycle, with the billing reimbursement taking far more time to realize, or frequent reports of denials. A better proactive processing system that can tactfully solve ICD-10 intricacies will be indispensable.

Upgrading Information Management and Technology

Successful implementation requires a matching deployment of technology application and system in congruence with ICD-10 demands. Therefore, healthcare organizations should look installing advanced systems, and at integrating them across all functional points within the organization.

Post Implementation Review

Implementing alone will not yield the desirable objectives; there will be regular review and audit of the implementation, which will not only ensure revenue optimization, but also and quality data dissemination for research and archiving.

With such an arduous task ahead, physicians or hospitals can safely resort to availing services of medical billers who are proactive and prepared with material-requisites for ICD-10.

MedicalBillersandcoders.com (www.medicalbillersandcoders.com), with a long-standing reputation of being the largest consortium of medical billers in the U.S., is a preferable catalyst in smooth transition to ICD-10.

For more information visit: Boston Medical Billing, Bridgeport Medical Billing

Professional Revenue Cycle Management Consultancy Services by Medicalbillersandcoders.com

MBC offers expert consultancy services to healthcare providers across the US for strategic, operational, and revenue cycle management, no matter the size of their organization. Viewing the dynamic changes sweeping through the healthcare industry, we have perceived an urgent requirement of professional support and assistance to healthcare providers to adapt to the latest regulations and flux in the healthcare industry.

2012 is the year when health reform actually hits home and the healthcare providers need to put their practices in order, in terms of regulation compliances such as HIPAA 5010, ICD10, PQRI (Physician Quality Reporting Initiative), CPOE (Computerized Physician Order Entry), HIE (Health Information Exchange) along with the latest EHR updates.

The MBC consultancy professionals can effortlessly implement and integrate these compliances into physician’ system. This can save the physicians immense administrative complications and inconvenience during the transition process as also after the regulation deadline.

We believe that the regulation related changes are not complex per se; the challenge lies in actively motivating the physicians’ teams to adopt these compliances by underlining their relevance and scope in effective patient healthcare and improved revenue cycle management.

The niche of Medicalbillersandcoders.com remains revenue cycle management and solutions to problems around optimized revenue cycles. MBC as a market force believes that it is best equipped to handle physician difficulties given its hundreds of billers and coders who cater to all specialties and face operational difficulties everyday.
MBC offers comprehensive consultancy services to optimize the revenue generation of healthcare providers by a thorough analysis of their revenue cycle management. Our experts minutely scrutinize the various stages of revenue cycle management to identify the root causes of revenue leakages and inefficiencies in order to provide pro-active solutions for healthy revenue generation.

MBC aims to provide value-added consultancy across the spectrum of healthcare services throughout the US.

Baltimore Medical Billing | Birmingham Medical Billing | Boston Medical Billing

Primary care Physicians to be the most affected by the proposed 30% CMS Cuts on Medicare payment for 2012

The physicians’ proposed fee schedule issued by the Centers for Medicare & Medicaid Services (CMS) for 2012 includes approximately 30% payment reduction in Medicare payments. If the proposed Medicare cuts become a reality, it may result in the primary care physicians, both government employed as well as private physicians, withdrawing from Medicare, as it is bound to turn the odds against them in terms of financial feasibility.

This will ultimately affect the end users i.e. the patients, particularly the senior citizens as their access to physicians is likely to reduce. A large number of physicians are looking forward to a permanent solution for this problem which can be achieved through the proper implementation of sustainable growth rate (SGR) factor.

With the inevitable incorporation of latest regulation such as EHR, PQRS, and ePrescribing in the healthcare scenario, the role of primary care physicians is set to be even more pertinent and active, putting more burdens on them. This might further aggravate the situation envisaged by the proposed 30% Medicare cuts.

The physicians need to gear up to face this challenge of payment cuts by making their system more efficient. They can hire experts to handle their revenue cycle in order to concentrate more on their core competencies like patient care and research. These experts can optimize physicians’ billing and coding process to enhance their reimbursement cycle. This will definitely go a long way for physicians to sustain their business profitably even after the Medicare cuts.

Albuquerque Medical Billing | Atlanta Medical Billing | Austin Medical Billing

Latest Coding Resources and Products Available Online, for a Fee

Coding is a very crucial step in a clinic’s revenue cycle process and coders need to keep themselves updated with changing industry regulations and norms to remain competitive. But the question is how? The latest online coding resources offered by the American Medical Association have come as a blessing for the coders by providing electronic access to authoritative coding and compliance resources, as well as updates to the latest coding, billing and compliance changes.

The AMA Coding Online has made available some of its best selling coding products such as CodeManager® in various editions, CPT® Assisstant with latest updates and historical information, RBRVS DataManager as well as many more. These products carry current updates (including quarterly/annual updates) as well as historical changes and are available with clinical examples, illustrations, and description in relevant cases.

The website is a veritable storehouse of latest coding resources and products for coders who would like quick and pertinent answers to their routine professional queries and stay abreast of the changes and trends; it also provides the physicians with a readymade facilitator to train their staff as well as authenticate coding to external sources.

For More information visit: Baltimore Medical Billing, Birmingham Medical Billing

ICD-10 Implementation: An update for physicians and coders

The transition to ICD-10 is much more than a mere increase in codes and field sizes. The descriptions of diagnosis codes in ICD-10 may be very different to what coders are used to seeing and using in ICD-9. Therefore, the complexity in transition is significant and shouldn’t be avoided by medical coders.

An easier and successful transition before October 1, 2013 would require a well planned and efficiently managed implementation process. Although the ICD-10-CM/PCS implementation deadline is two years away, good training plans will ensure a smooth transition for physicians, inpatient and outpatient coders.

Browse All: Medical Billing

Impacting Inpatient Coders:

The ICD-10-CM/PCS final rule estimates that inpatient coders will need 50 hours of training. In order to ensure a successful transition, inpatient coders must:

• Possess sufficient foundational knowledge of the biomedical sciences (e.g., anatomy, physiology, patho physiology, pharmacology, and medical terminology)
• Learn how to apply ICD-10-CM/PCS codes correctly on inpatient encounters
• Understand how to apply maps and crosswalks between ICD-9-CM and ICD-10-CM/PCS

Impacting Outpatient coders:

Outpatient coders would require approximately 16 hours of effective training in ICD-10-CM/PCS, presuming that coders already has the necessary knowledge in biomedical sciences. Other requirements are same as inpatient coders.

Medical coders need to adhere to the stipulated timeline for the various steps of ICD-9 to ICD-10 transition. Though the first phase is already over, the coders can still take assistance from various online resources and webinars conducted by AMA, AAPC, AAHIMA, and many other associations to get the requisite training and prepare for the transition process. Proper training and guidance in using use ICD- 10 will help coders to remain abreast with the changing industry norms and play a vital role in the implementation process for their employers and clients.

Physicians should keep track of the envisaged timeline for implementation of ICD-10 and prepare their clinic for smooth transition through its various phases:

Phase 1: Implementation plan development and impact assessment (first quarter 2009 to second quarter 2011)

Phase 2: Implementation preparation (first quarter 2011 to second quarter 2013)

Phase 3: “Go live” preparation (first quarter 2013 to third quarter 2013)

Phase 4: follow-up post-implementation (fourth quarter 2013 to fourth quarter 2014)

Physicians should also ensure training for in-house coders, or hire coders trained in using ICD-10, as proper coding is required to keep their revenue cycle efficient and optimized. For physician practices or hospitals facing problems in getting their staff upgraded, outsourcing might be a feasible option.

For More information visit: Charlotte Medical Billing, Cleveland Medical Billing

Synchronizing ePrescribing, PQRS, and EHR Criteria

There can be many issues with a conventional paper prescription issued by a doctor. To begin with, most chemists find it difficult to understand illegible handwriting on the prescription, leading to disbursement of wrong drugs or dosages. Secondly, patients may need to return to the doctor for changes in the prescription, such as, extending it, or authorizing substitute medication due to non-availability of prescribed drugs. Thirdly, the chemist may not have the medication prescribed and the patient may have to run from chemist to chemist to get the medication and the list goes on.

A lot of prescriptions are misused and dangerous drugs are procured over the counter. One way is for the patient to get the prescription filled and then go to another chemist and fill it again, if the chemist fails to mark the prescription as filled. Thousands of patients die from wrong medication every month and to prevent such deaths, the US Department of Health & Human Services set up the CMS (Centers for Medicaid & Medicare Services) to oversee what is called the Physician Quality Reporting System (PQRS).

In order to effectively solve the above mentioned problem and ensure all physicians and medical professionals adhere to quality practice norms, the CMS set up the PQRS that requires all medical professionals to register by law and offered incentives to medical professionals to sign up for the eRx system to combat the above mentioned problems.

The electronic network of computer systems called ‘eRx,’ or electronic prescription (ePrescription for short) has effectively resolved all the problems faced by doctors, patients and chemists alike. Patients covered by Medicare can benefit from this facility.

Browse All: Cleveland Medical Billing

Getting Started

It is never too late to get started with the CMS PQRS. First of all, any medical professional wishing to get into the eRx, or ePrescription incentive program needs to check with the list of eligible professionals. These include, but are not restricted to:

1. Doctor of Medicine
2. Doctor of Osteopathy
3. Doctor of Podiatric Medicine
4. Doctor of Optometry
5. Doctor of Oral Surgery
   
6. Doctor of Dental Medicine
7. Doctor of Chiropractic
8. Physician Assistant
9. Nurse Practitioner
10. Clinical Nurse Specialist
11. Clinical Social Worker

In fact, all professional services covered under the Medicare Physician Fee Schedule (PFS) and physicians charging fee based on the PFS qualify for the PQRS. However, eligible professionals do not have to participate in the PQRS to take part in the eRx or ePrescription incentive program of the Electronic Health Record system.

While there is no sign-up or pre-registration for the eRx incentive program, there are some EHR criteria to be eligible. This includes the professional using any of the qualified eRx systems and reporting to the CMS on his or her adoption of the system. Then the professional must satisfy certain qualifying criteria by using the eRx system for a specified reporting period.

To sum things up:
The incentive is a financial compensation for the medical practitioner that amounts to 2% of a group practice’s total allowed charges for professional services that are covered under the Medicare Part B Physician Fee Schedule, as laid down by the CMS. 

Health care providers should ensure that at least 10% of its Medicare Part B charges will be reporting to a particular set of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. 

This reporting is required for at least 50% of the Medicare Part B patients that the professional prescribed medication for in the reporting year. 

A professional may submit this information one of three ways: to CMS on its Medicare Part B claims, to a qualified registry, or to CMS via a qualified electronic health record (EHR) system. 

While the eRx incentive program was started in 2009 and implemented annually by the CMS that updated the Federal Registry regularly, this financial incentive is set to reduce to 1% by 2012 and further to 0.5% in 2013. In addition to this, all eligible healthcare professionals will face penalties in the form of reduced payments if they fail to meet eprescribing criteria. Should they fail to start eprescribing by 2012, their financial incentive will be reduced by 1%. Failing to do so by 2013 and beyond, the penalty will result in a reduction by 2% of the payment they would normally be entitled to. 

Undergoing dynamic changes in running a practice, physicians can utilize the support of well trained Medical Billers and Coders and even Practice Management staff. Finding this well trained staff across all 50 states and specialized in all specialties has become much simpler with Medicalbillersandcoders.com

To know more about RCM and Practice Management Consultant visit –www.medicalbillersandcoders.com Charlotte Medical Billing, Chicago Medical Billing

‘Meaningful Use’ completed its one year: How far has your practice reached?

Meaningful use of EHR or Electronic Health Records is one of the most discussed and debated topics in the recent heath care reforms. The main components of ‘Meaningful Use’ include the use of certified EHR technology for meaningful use such as ePrescribing, electronic exchange of health information to enhance healthcare quality, and submit clinical quality and other measures.

Adopting these health care IT reforms can assist physicians to provide quality care and increase their revenue by making the process of payment quicker and by avoiding preventable errors. However, the incentives offered for implementation of EHR can differ according to when the EHR are adopted by physicians or hospitals and by measuring other parameters in the service provided by physicians. These parameters can range from recording the status of smoking among patients to numerous others such as maintaining various lists.

The objectives laid down by the HITECH Act are divided into two parts – the core set and the menu set –which define the measures to be taken in order to qualify for the incentives provided by the Federal Government. The core set consists of recording patient demographics, recording vital signs of the patients such as height, weight & BMI (Body-mass index), maintaining lists of current and active diagnoses, record smoking status of 13 years or older population, provide patients with clinical summaries for each office visit, provide patients with a copy of their health information. They can also generate and transmit permissible prescriptions electronically among other core set of objectives.

Meaningful Use is categorized into three stages – stage 1 which began in 2011, and stages 2 and 3 which are planned for 2013 and 2015 respectively. There are 25 objectives or measures for eligible providers (EP) for stage 1 whereas stage 2 and 3 would expand upon stage 1 criterion. Meaningful use of EHR can also be categorized under Medicare and Medicaid incentive program where the former would pay $44,000 over a period of five years as an incentive and the latter $63,750 over a period of six years. To receive the maximum incentive under Medicare, EPs must begin participation by the year 2012. Medicaid incentive program is voluntarily offered by individual states and can begin as early as 2011.

Browse All: Cleveland,OH Medical Billing

Those Eligible Physicians, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use after the year 2015 would face payment adjustments in their Medicare reimbursements. However, there is no payment adjustment for providers under Medicaid. Therefore it becomes important to ensure that your practice successfully starts meaningfully using EHR before 2012 in order to be eligible for incentives for Medicare. According to CMS the last day for Eligible Physicians to register and attest in order to receive incentive for calendar year 2011 is February 29, 2012.

The EHR Demonstration is a five-year project intended to support small to medium-sized primary care physician practices to implement and utilize EHRs to develop the quality of patient care. Practices participating in the EHR Demonstration that meet particular requirements are entitled to obtain two categories of incentive payments: one for the implementation and utilization of an EHR and the other for the reporting of and performance on twenty six clinical quality measures linked to the care of coronary artery disease (CAD), congestive heart failure (CHF), diabetes mellitus (DM), and preventive care services.

Many physicians may find it hard to just drop Medicare patients since the number of insured will go up drastically due to health reforms. Moreover, once EHR or EMR are adopted, physicians and Eligible physicians would find it much easier to handle patients and also save time and money. This fact coupled with the incentives provided would certainly increase the total revenue by more than 10 to 15 percent. Therefore adoption of EHR or EMR would become inevitable in the near future.

In the light of the increased use of technology, routine adoption of quality- and performance-based reimbursement models, and the constantly changing dynamics between the stakeholders are bound to redefine the healthcare business processes. The use of expert billing and coding professionals and staff which is trained on the latest EHR criteria and possesses domain expertise can optimize the revenue, speed, as well as value of healthcare clinics and hospitals.

For more information about successful implementation of EMR and EHR or PMS, please visit medicalbillersandcoders.com, Charlotte Medical Billing, Chicago Medical Billing

Assess the capability of your workforce: Is your clinic administration in the right hands?

The capability of your workforce as a physician is directly impacted by the number of people you hire and the efficiency of the staff. Ideally every business entity needs to find the right balance between the number of people employed and the profits or revenue that they help generate. This factor along with the efficiency of your staff directly affects your revenue and accuracy. Physicians in the United States face numerous challenges when it comes to choosing the right administrative staff because of the ever changing face of the health industry. Therefore it becomes important to analyze whether the administrative aspect of your practice is in the right hands.

The clinical staff cannot completely focus on your patients and handle the negotiations with insurance company all at the same time. Even if this is possible, it may drive down the profits due to errors from work overload. The best solution for this problem is to hire extra staff or medical billers and coders who are experienced in this field. Even though this may increase your investment in staffing, it will also increase your revenue, justifying the addition of such experienced medical billers and coders.

The three most important professionals that affect your productivity are the assistants, the receptionist and the support staff for billing and coding who can also negotiate and interact with payers. The most crucial role played in the administrative and revenue cycle management is that of medical billers and coders. It is important to hire medical coders and billers who are excellent in technical skills, have updated knowledge of HIPAA guidelines, and have experience in handling negotiations with payers. The technical skills required in medical billing and coding is not just about having good computer literacy but is also about numerous other qualities such as good communication skills and knowledge of recent trends in reimbursement in your specialty.

There are numerous other ways of enhancing your staff's productivity and these may be as practical as optimal utilization of office space to something as intangible as motivating your workers. Some simple ways of enhancing or gauging the efficiency of the staff is measuring individual productivity, revising methods to modify or channel employee behavior and talent in the right direction, setting clear goals that are achievable, rewarding the staff whenever required, and keeping a follow-up by evaluating whether the changes made are having a positive financial impact on your practice.

The reforms in the health care IT sector have also affected physicians dramatically, and utilizing latest technology such as EHR (Electronic Health Records), using practice management software efficiently and other IT tools has become necessary.

EMR system support and training are also important when deciding whom to hire to run the EMR system. Without an effective EMR installation, your practice may not be entirely proficient. EMR systems can profit medical facilities in numerous ways; the reports driven from an EMR can highlight the lacunae in a physician’s system and staff productivity. EMRs with facilities to audit logs, assigning tasks to specific staff member and regular follow up and reminders on pending tasks, provide tools to streamline systems. This means that EMR not only improve patient care but also assist in increasing the revenue in the long run. Efficient use of EMR or EHR is one of the most important aspects of the administrative side of a physician’s practice.

Assessing the productivity and capability of your administrative staff is a job that entails not just number crunching but also the level of patient satisfaction, the amount of time saved due to professionalism, the accuracy of medical billers and coders, HIPAA compliance, and meaningful use of the technology that is adopted for billing and coding. If all these aspects do not result in improved revenue over a period of time then it would be better to look for staff and medical billers and coders who can do the job efficiently and in a timely manner.

For more information about improving the productivity and appraisal of administrative tasks, please visit medicalbillersandcoders.com, Atlanta Medical Billing, Austin Medical Billing.

Source: Medical Billing

The Need for a Long-Term Solution to the Perennial SGR Problem

The decade old uncertainty over fixing a permanent solution to Sustainable Growth Rate (SGR) is set to continue with the House deciding not to set off the accumulated deficit (25% for 2011) against primary care physicians till the end of this year. Although a temporary relief for doctors, the absence of a permanent solution will always keep doctors apprehensive every year. What is more, the accumulating deficit is destined to move upwards.

Primarily brought into force by the Balanced Budget Act of 1997 to amend Section 1848(f) of the Social Security Act for controlling costs related to spending on Medicare expenditure by the Centers for Medicare and Medicaid Services(CMS), Medicare Sustainable Growth Rate (SGR) happens to be an overriding improvement over the earlier method, the Medicare Volume Performance Standard (MVPS).

As the SGP advocates equating Medicare expenditure for each beneficiary proportionate to the growth in the GDP, physicians are driven to render quality service under the GDP sealing. Despite Medicare Payment Advisory Commission's close watch - advisory to the U.S. Congress on the previous year's total expenditures as against the target expenditures, and conversion factor that modifies the payments for physician services for the next year in congruence with the target SGR - the Medicare Sustainable Growth Rate has never been able to witness the Medicare expenditure in congruence with the GDP.

Although the CMS may place partial blame on physicians for overshooting the SGR every year, yet, amidst ever-rising cost of medical practice, physicians have been finding it hard to sustain the SGR. The estimated SGR for 2010, which is a negative 10.30%, and the conversion factor for the physician fee at a negative 25% are still more alarming. The current scenario would have meant a negative Medicare budget, and cut in physicians' fees by 25%, in which case physicians would have resorted to boycott the Medicare patients.

In the long run this scenario is also going to affect the quality of healthcare as the physicians would be wary of investing money in new equipment or latest technology to enhance their patient care and management services if they are unsure of their potential revenue and expenses. Another pertinent fact here is that the implications of the SGR stalemate go beyond Medicare as most private insurers take a cue from Medicare to set their payment rates.

Fortunately, like it has been since 1997, there has been yet another extension to the implementation of conversion factor; Medicare and Medicaid Extenders Act of 2010 has deferred it till January 1, 2012. But at some point of time, the inevitable question will have to be answered and permanent solution to be given amidst booming demography of senior citizens, which will further escalate SGR problem. It is heartening to see the premier health body, AMA actively pursuing the issue with the congressional leadership for a long-term solution.

We, Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billing and coding advisory are equally interested in witnessing a permanent solution to this perennial SGR problem. Being an integral part of medical endeavors, we hope it is realized sooner.

For More Information Visit us: Charlotte Medical Billing, Chicago Medical Billing

Source: Medical Billing

Towards Realizing Medical Data Integration Nationally

The benefits of Integrating Medical Data nationally can be far-reaching. Given its multi-applicability, Macro-level Medical Integration Of Data can enable enhanced medical service and cost-efficiency, privacy compliance as per HIPAA, transparent billing and coding as per CPT, ICD-9, & HCPCS procedures, ready availability of health data for numerous references and verifications, advanced clinical research with comprehensive data, and more importantly primary source of data for Federal Health Policies.

Although its idea of implementation traces back to as early as the advent of data integration models for healthcare industry in the early 90's of the last century, it is yet to realize its objective owing to financial and policy reasons.

But, what is encouraging is the fact that the recent amendments to Federal Healthcare Policy have emphasized the need to speed up the process, and given boost both in terms of finance and policy. Further, it has urged all healthcare professionals and institutions to respond to its cause by upgrading their data compilation to advanced information platforms like HealthCare Data Warehousing and Networking, which again can be linked to a centralized or master server.

Browse All: Medical Billing

Easier said than done, the endeavor requires a chain reaction involving physician level integration, institutional level integration, and regional level integration leading ultimately to National Level Healthcare Data Integration. This is where a well-coordinated effort is required to link all the participative entities. Needless to say, Federal Executive Health Bodies have a major role in ensuring a seamless coordination among Federal, Private and NGOs.

IT providers, who have been associated with inventing and implementing healthcare solutions, are of the consensus that Clinical Information System - which aids in clinical decision making, improving evidence-based practice, and enhancing communication among providers, and policy and privacy decisions by Federal Health Body - can be the solution for successfully realizing the goal of a national level integration of healthcare data, and digitally revolutionize the creation and maintenance of integrated medical data.

Thus, there is no uncertainty as to healthcare sector - priority sector in the United States' economy - being an immense beneficiary of application of technology, and in particular, medical information data warehousing and networking.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) - being the largest consortium of medical and billers in the U.S., and integral part of healthcare industry - has been actively responding to the cause through application of advanced billing and coding software and hardware that enable transparent data generation, transformation and networking across wide information channels.

For More Information Visit us: San Diego Medical Billing, San Francisco Medical Billing

Source: Medical Billing